Stories from the Road: Pittsburgh to Peru

A shipment of donations arrives from Brother’s Brother Foundation (BBF).

Brother’s Brother Foundation (BBF) is a nonprofit organization with a long history of acquiring medical instruments and equipment to distribute to low-resource countries. The University of Pittsburgh Department of Otolaryngology-Head & Neck Surgery (PittENT) and the Eye & Ear Foundation of Pittsburgh are partnering with BBF to aid the otolaryngology-head and neck surgery landscape in Peru by providing equipment, expertise, and education programs.

PittENT has a rich tradition of international outreach and dedication to training otolaryngologists from around the world. The department’s founding Chair Eugene N. Myers, MD, FRCS Edin (Hon), Past President of the AAO-HNS/F and the first International Coordinator, has been a leader in training and mentoring otolaryngologists from around the globe for decades.

Eugene N. Myers, MD, FRCS Edin (Hon), Past President of the AAO-HNS/F and the first International Coordinator.

“I have devoted a great deal of my career to improving international relations in otolaryngology. Since 1981, PittENT has received several thousand otolaryngologists from all over the world to observe for varying periods of time. Many of these individuals have returned to their countries, become chairs of their respective departments, and have then trained residents using what they learned during their time with us," said Dr. Myers. “We currently have commitments to host otolaryngologists from Lithuania, Turkey, Peru, Pakistan, Greece, Canada, and Vietnam.” The department also hosts specialty courses throughout the year that attract international attendees, including an internationally acclaimed course in skull base surgery led by Carl H. Snyderman, MD, MBA, a world-famous skull base surgeon.

Bridging Countries and Generations

José P. Zevallos, MD, current Chair of PittENT.

The current Chair of PittENT, José P. Zevallos, MD, is dedicated to continuing this tradition of international outreach and training. Dr. Zevallos was born in Lima, Peru, and has developed strong relationships with the otolaryngology-head and neck surgery community in Peru. Recently, he has worked with Peruvian leaders in the field to discuss combined residency training, as is done in the United States. Currently, otolaryngology and head and neck surgery are separate training programs and specialties in Peru. There is a growing interest in developing combined training programs and more collaboration between the two specialties. Dr. Zevallos and PittENT are poised to play a central role in these efforts. 

Three generations of PittENT Chairs: (left to right) Jose P. Zevallos, MD, Jonas T. Johnson, MD, and Eugene N. Myers, MD.

Although he only joined PittENT two years ago, Dr. Zevallos understands the departmental history he is now part of and sees this project as an opportunity to impact even more people around the world. “Much of our department’s legacy has been as an international leader in otolaryngology and head and neck cancer care, thanks to Dr. Myers,” said Dr. Zevallos. “This project in Peru extends that mission into a new part of the world and ties together not just the educational mission that we’ve always been known for, but also a service-related mission that will help patients in need of advanced otolaryngology and cancer care.”

A shipment of supplies from BBF arrives in Ghana.

“BBF is thrilled to collaborate with PittENT and Dr. Myers and Dr. Zevallos, in particular, on the Peru program,” said Ozzy Samad, President of BBF. “It is an initiative that directly addresses our focus on working with in-country partners to help improve patient wellbeing in underserved communities, while also providing educational opportunities for medical practitioners.”  

Location and Needs

According to Dr. Zevallos, improving the accessibility and quality of otolaryngology care in Peru is vital. A priority of the Pittsburgh-Peru initiative is to train Peruvian surgeons in the latest advances in otolaryngology-head and neck surgery in a way that can be translated to the realities of caring for complex patients in a developing nation. Much of the expertise in otolaryngology and head and neck surgery is centralized in Lima, the capital city, where approximately one-third of the population resides. This means that two-thirds of the patients must travel long distances to receive any specialty care. Despite there being state-sponsored insurance for patients in need, patient wait times are long and access to highly trained specialists is severely limited. 

“Outside of a few select centers, many of the technological components of otolaryngology care that we take for granted in the United States, such as video capability, endoscopes, cochlear implants, and sinus navigation are limited in Peru,” explained Dr. Zevallos. “Not only does this lack of resources limit the care that can be delivered today, but it also hampers the ability to train future otolaryngologists.”

A Two-Way Collaboration for Education and Research

PittENT’s goal for the new initiative is to create a pathway to collaborate on research and training between Pittsburgh and Peru. Phase one of this goal is acquiring and donating otolaryngology instruments and equipment that will be sent, in partnership with BBF, to hospitals in Peru that are in need. The university will also provide virtual education programs for Peruvian residents in otolaryngology head and neck cancer, including opportunities to participate in the department’s grand rounds programming.

Doctors in both Pittsburgh and Peru will have the opportunity to spend time at facilities abroad. Dr. Zevallos and his team plan to create a three-month observership for Peruvian doctors to come to Pittsburgh to observe surgery, surgical laboratories, and research projects, all while working alongside world-class surgeons in the department. These observerships would include all subspecialties, including head and neck surgical oncology, skull base surgery, rhinology, sleep surgery, and neurotology. There are also plans to hold an annual “Pittsburgh in Peru” otolaryngology-head and neck cancer surgery meeting in Peru, which would include lectures, expert panels, surgical laboratories, and resident research competitions.

“A bidirectional collaboration with physicians in Peru will not only be educational for the residents and trainees in Peru, but also for our residents and trainees here in Pittsburgh, to gain a more global perspective of our field,” said Dr. Zevallos.

Once phase one has been implemented and connections have been made with Peruvian hospitals and otolaryngologists, PittENT intends to provide its residents with rotations in Peru, offer an international head and neck surgery fellowship for Peruvian doctors to train in Pittsburgh, and establish a global health track for one PittENT resident per year to work with partners in Peru to identify and implement a longitudinal research or service project.

New Opportunities for Global Otolaryngology Training

Although this project is just getting started, thanks to Dr. Myer’s efforts throughout his career, there are already resources available for international missions and training in otolaryngology-head and neck surgery. “I was the founder of the Academy’s International Affairs Program, which provides educational opportunities for otolaryngologists worldwide,” said Dr. Myers. Committed to providing education and services for international otolaryngologists, Dr. Myers has forged global partnerships and expanded education opportunities on behalf of the Academy for decades.

To honor his limitless contributions, the Academy has recently established the Eugene N. Myers, MD Global Education Fund, which provides funding for otolaryngologists from resource-poor countries to access otolaryngology professional development resources offered through the AAO-HNS. Grant awardees are able to improve their knowledge base to provide care for patients in their home countries, thus building upon Dr. Myer’s dedication and commitment to the global otolaryngology community.

A Successful Model for Improving Patient Care Worldwide

Fundraising efforts for the Pittsburgh-Peru project are already underway and are being led by BBF and the Eye & Ear Foundation. Although both organizations have their roots in Pittsburgh, they are setting their sights internationally to ensure more people can receive the high level of care that they need. With the help of Dr. Myers and Dr. Zevallos, Mr. Samad sees this as the start of a successful and replicable program to help patients around the world.

“Dr. Myers' vaunted standing in the otolaryngology community has already been key in receiving support and collecting needed instruments from donor partners across the U.S.  Similarly, Dr. Zevallos' expertise in the field—along with his familiarity with the healthcare system in his native Peru—are key factors that will undoubtedly lend themselves to the success of the program. We cannot overstate our excitement and enthusiasm for this collaboration!